The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

November 19, 2008 #3,404 Editor-Barry Block, DPM, JD

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IL Podiatrist Answers Shoe-Fitting Question

Last year, volunteers with the Illinois Podiatric Medical Association fielded about 100 calls, many of them asking questions related to neuropathy, which causes pain or numbness in the feet. To get the ball rolling this year, we asked a few questions of our own.

Q I'm in-between sizes, should I buy up or down? Is it better to slip around or scrunch up?

A "Neither," said Stephanie C. Wu, assistant professor of surgery at Rosalind Franklin University of Medicine and Science in North Chicago. "If you buy a size up or down, the foot is subjected to abnormal shear forces resulting in pain and blisters. Try looking for brands that make half sizes [a shoe size varies by only 1/8 of an inch] or shopping in the late afternoon or evening since our feet tend to be bigger at the end of the day.

Dr. Stephanie Wu

If you're truly stuck, it's probably better to err on the slightly larger size, as an insole can often be used to fill in the extra space. Make sure the heel does not slip or rub."

Source: Julie Deardorff, Chicago Tribune, IL [11/16/08]

More Physicians Coming to Congress

Each of the 10 physician lawmakers vying for re-election to Congress prevailed at the polls. They will be joined in January 2009 by at least three additional physicians who won seats in the House of Representatives. A House race involving John Fleming, MD, a Republican internist from Louisiana, will be decided Dec. 6.

Re-elected
Sen. John Barrasso, MD (R, WY), orthopedic surgery
Rep. Charles Boustany, MD (R, LA), cardiovascular surgery
Rep. Paul Broun, MD (R, GA), family medicine
Rep. Michael Burgess, MD (R, TX), ob-gyn
Rep. Phil Gingrey, MD (R, GA), ob-gyn
Rep. Steve Kagen, MD (D, WI), internal medicine
Rep. Jim McDermott, MD (D, WA), psychiatry
Rep. Ron Paul, MD (R, TX), ob-gyn
Rep. Tom Price, MD (R, GA), orthopedic surgery
Rep. Vic Snyder, MD (D, AR, family medicine

Newly elected
Rep. Bill Cassidy, MD (R, LA), family medicine
Rep. Parker Griffith, MD (D, AL), medical oncology
Rep. Phil Roe, MD (R, TN), ob-gyn

Source: AMNews [11/24/08]

Gear Up For Goals Success

You have set some motivatiing, achievable goals. Now what? Take these steps to make progress:

• Schedule it. Set aside 30 minutes each day to do something that moves you closer to one goal. Don't expect to do it in one day; the key is to build on the progress you made the day before.
• Build the success habit. Work towards your goal at the same time each day. When "goal time" becomes part of your daily routine, you will start to see real progress.
• Keep going. When you reach one goal, don't sink back into a state of inertia. Celebrate your success and then prepare to tackle a new goal.

Source: Adapted from Get What you Want in 30 Minutes: Six Tips for a Successful Life by Theodore Carl Sodenberg via Communications Briefings.

Query: Sarcoidosis and Lamisil

Does anyone know if Lamisil tablets can be used in a patient with sarcoidosis?

Bonnie Tatar, DPM, Pittsburgh, PA

Query: Network-Based Appointment Scheduling Software

We are looking for a recommendation of a patient appointment scheduling software that can be accessed over a network and by more than one person at a time.

Robert S. Schwartz, C. Ped., NY, NY

Query: Billing Orthotics During a Post-op Global

I have a patient that I performed an excision of an accessory navicular, left foot, at the end of September. She also has an accessory navicular on the right foot, but it is not symptomatic. The patient stands all day at work, and would like custom orthotics made. She wants these before the end of the year because (with the surgery) she has already met her annual deductible.

My concern is that her 90-day global will also last until the end of the year. How should I bill for the orthotics during this time? I was thinking I needed to use the "-58" modifier, but wasn't sure.

Amy Jelinek, DPM, Greensburg, IN

Response: You can bill for DMEPOS items during the global period including orthotics, braces, and assistive devices such as crutches, walkers and wheel chairs. They are not included or effected by the global period. They are, however, subject to medical necessity.

Mark Schilansky, DPM, Catskill, NY

Codingline subscription information can be found here

RE: Varus 5th Hammertoe in a 12 Year Old (Richard Frost, DPM)
From: Multiple Respondents

Intervene using the Osteomed Flexible Stabilization Rod. The proximal stem does not cross the epiphyseal plate of the proximal phalanx.

Osteomed Flexible Stabilization Rod

This "rod" would stabilize the digit without shortening the toe.

Don Blum, DPM, JD, Dallas, TX, donrblum@sbcglobal.net

Many years ago, podiatric surgeons employed a procedure called a "phalangeal set." It was used primarily for this type of case and consisted of a soft tissue release - (in this case) of the medial ligaments at the PIP and the DIP joints of that digit. Local anesthetic, a tourniquet (if you prefer) and a #64 blade is all that's needed. Sutures are discouraged, as they will encourage the original malalignment, and this can be done safely in an office OR.

Splinting the digit in a corrected attitude for healing allows fibrosis to occur, and the digit will remain anatomically correct. Since motion at this location is generally not missed, a pleasing cosmetic result is the goal. No bony work will interfere with growth plates and the long-term concerns of corn/callus formation will be minimized.

Bruce Smit, DPM, Frankfort, IL, Footbiz@sbcglobal.net

Editor’s note: an extended-length letter Dr. Barry Mullen appears at: http://www.podiatrym.com/letters2.cfm?id=23168&start=1

RE: ASPS, APMA’s New Surgical Affiliate
From: Nicholas Brown, DPM, Irv Kanat, DPM,

I am absolutely dismayed by the decision of the APMA to form its "own" surgical podiatric society. If the whole point is to create even a bigger divide in our profession, this would be it. I would find it hard to believe that most APMA members would belong to both ASPS and ACFAS. It is absurd and may eventually be the last straw for many members to "jump ship" and not renew their membership in the APMA. According to ACFAS, they are enjoying a significant increase in membership. Meanwhile, the APMA grovels about antiquated bylaws and need for dual membership in both societies.

We need unity and creating "another" surgical society only creates more confusion to anyone outside of our profession. APMA is doing a huge disservice to the lay public and the healthcare field by creating such a trivial entity. The proverbial writing is on the wall and we may have a new predecessor for the voice or our chosen profession: The American College of Foot and Ankle Surgeons.

Nicholas Brown, DPM, Wooster, OH, nb78910@yahoo.com

It’s interesting how a well-intended effort directed at unity, inclusiveness, and cooperation that had to be borne out of other's attempts at divisiveness, power-seeking and self-aggrandizement, can be so quickly misunderstood!

The now developing new potential affiliate of APMA, the American Society of Podiatric Surgeons, Inc. has, obviously, been developed to be supportive to APMA, and not a detractor; To be responsive to the profession, and not an alienating influence; To be inclusive in its very structure and processes, and not elitist; To function positively with APMA, and not be a recalcitrant influence; To make the profession, and the Association stronger, as a unifier; To assist the Association in the myriad of broad obligations and commitments of our profession; To work cooperatively, to achieve the goals to which we all aspire; and, To overcome some of the narrow, status-seeking interests that have characterized some of our history.

How can we not welcome and support this new effort? For when we do, we support the Association to which we all owe so much.

Irv Kanat, DPM, West Bloomfield, MI, ikanat@maxai.com

ISO CONSULTING/MANAGERIAL OPPORTUNITIES FLORIDA

Established practitioner, with extensive clinical and practice management experience, is retiring to Florida, and is seeking consulting/managerial opportunities within podiatry or in general health care in the Broward County/Palm Beach County area. Could also provide expertise in product/educational development. Please email responses to retiredpod@gmail.com

EQUIPMENT FOR RENT - EXTREMITY MRI

Now you can rent an extremity MRI, have the scan performed, read by a board-certified radiologist and derive all the income. two convenient locations, Manhattan East 60th street between Park and Lexington, and Plainview, Long Island. Conforms to the Stark amendment; call for information (516) 476-1815.

LOOKING FOR FINANCIAL SECURITY?

Our practice continues to grow and we’re in search of a motivated, well-trained DPM who is great with patients. Our multi-office practice is located in the scenic Hudson Valley region of New York State. This is a great career opportunity for the right person(s), with an excellent compensation package available. Please reply to Hudson Valley Foot Associates, PO Box 3300, Kingston, NY 12402-3300; or email CV and cover letter to: jobs@hvfa.com

ASSOCIATE POSITION – MASSACHUSETTS

Excellent opportunity for a highly-motivated, entrepreneurial individual to join a very successful, rapidly growing multi-office practice, North of Boston. Seeking a PSR-24/36 trained podiatrist to join our group. We offer a competitive salary/benefit package with the opportunity of partnership after one year, for the right individual. Send CV and letter of interest to drfleishman@nefootankle.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for full-time podiatrist in a multi practice location in the Chicagoland and Northwest Indiana area. Must have two years of surgical residency. Please e-mail resume to d-kitchens@footexperts.com

ASSOCIATE POSITION –GEORGIA

ASSOCIATE POSITION – ST. LOUIS, MISSOURI

Excellent opportunity for PSR 24-36 foot and ankle surgically-trained physician. Looking for hard-working, personable, highly-motivated individuals to join our group and build their own practice. Position leading to partnership. Great opportunity with excellent salary and benefits. Please e-mail CV and references to cavallinig@foothealers.com

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for part-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to f-massuda@footexperts.com

CASE CONSULTING

Dennis Shavelson, DPM is now accepting referrals of difficult cases involving biomechanics, surgical complications, non-healing wounds diagnostic and treatment dilemma’s and subtalar stenting from DPM’S. Full reporting with second opinion only, rapid return after care and assumption of care options. Medicare and Out-of-Network Only. (212) 288-3668 or drsha@lifestylepodiatry.com

PODIATRISTS NEEDED - CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. Full and part-time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

ASSOCIATE POSITION AVAILABLE-MIDTOWN MANHATTAN

Looking for Full-time associate to work in well established practices in midtown Manhattan and Forest Hills. Immediate opening for PSR 24-36 surgically trained Podiatrist. Great opportunity with competitive salary along with malpractice benefits. Please send CV to slurie@papapc.net

POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes.Top hospitals. Fax CV with references to 703-491-9994

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